Angiolymphoid Hyperplasia with Eosinophilia

A 19-year-old female presented with multiple reddish, elevated lesions over the right ear for 2 years with complaints of pain and bleeding on manipulation of lesions. There was no history of preceding trauma. Dermatological examination revealed multiple, erythematous, firm, nontender nodular lesions of varying sizes (3–10 mm), present over concha [Figure 1a] and posterior aspect of the right ear [Figure 1b], blocking the external auditory meatus. There was no regional lymphadenopathy. Systemic examination was normal. All relevant investigations including complete blood counts were normal. Histopathological examination showed the proliferation of vascular channels lined by plump endothelial cells as well as nests of endothelial cells seen in the dermis [Figure 2a]. A moderate dermal inflammatory infiltrate comprising lymphocytes, plasma cells, and eosinophils was present [Figure 2b]. The findings were consistent with the diagnosis of angiolymphoid hyperplasia with eosinophilia, also known as epithelioid hemangioma. Surgical excision is the treatment of choice, but as the lesions are often multilobulated and poorly delineated, local recurrences may be seen in 33-50% of cases. In addition, surgery can be disfiguring and difficult, especially in the periauricular region. Mohs micrographic surgery with complete margin examination has also been considered.[1,2] Our patient also underwent surgical excision, followed by recurrence after 4 months.

Figure 1.

(a) Multiple, erythematous, firm nodular lesions present over right concha blocking the external auditory meatus (b) Multiple, erythematous, firm nodules present over the posterior aspect of the right ear

Figure 2.

(a) Proliferation of vascular channels lined by plump endothelial cells and nests of endothelial cells in the dermis (H and E, 100×) (b) Moderate dermal inflammatory infiltrate comprising of eosinophils (red arrow), plasma cells (yellow arrow), and lymphocytes (H and E, 400×)

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